Extracts from Home and Foreign Journals. SURGICAL EARLY OPERATIONS FOR CEREBRAL HEMORRHAGES OF Dr. Charles H. Frazier, of Philadelphia, said that in order to put on a rational basis the surgical treatment of epilepsy, greater discrimination must be made in the selection of cases. No opportunity should be lost in operations upon epileptic subjects to observe as closely as possible the existing pathological conditions. A more intimate knowledge of the pathology of the disease was necessary for the establishment of a basis upon which to determine the propriety of operative intervention and the character of the same. Epilepsy developed sooner or later in from 30 to 50 per cent. of cases of infantile hemiplegia. In many of these the lesions had been proven by autopsies to have been a hemorrhage and in children the hemorrhage was often either on or near the cortex rather than intracerebral, as in adults. The tendency towards secondary degenerative changes, such as atrophy, and softening, the greater disposition in epileptic subjects towards mental defects, especially idiocy, and the otherwise hopeless nature of the disease constituted the principal arguments for surgical intervention.-Boston Medical and Surgical Journal. THE CONSERVATIVE SURGERY OF THE OVARIES. Dr. Edward Reynolds, of Boston, read this paper before Section of Gynecology and Obstetrics, Boston meeting A. M. A. (Med. Record). If cystic disease of one ovary existed it tended to disappear in the other. If one ovary was affected it was conservative surgery to remove the affected one, leaving the other. If both were affected, conservative surgery called for the removal of both, saving as much ovarian tissue as possible. Malignant neoplasms meant radical operation. After the child bearing age both ovaries should be removed if affected, the disadvantages of castration in such case being of minor importance as compared with the probability of second operation. Normal ovarian tissue could generally be found in benign tumors, and an effort to preserve as much as possible of this normal tissue should be made. Ovarian tumors could conveniently be classified as cysts originating from the corporea lutea, dermoid cysts, Graafian cysts, and enlarged sclerotic ovaries. Cysts of the corporea lutea would slip out through an incision, leaving practically normal ovarian tissue. Dermoid cysts and the larger cysts of the Graafian follicles must usually be excised. Enlarged sclerotic ovaries may be treated by puncture and removal of the lining membrane, with or without suture; resection; bisection of the ovary and multiple puncture or resection; and scarification or multiple incisions of the surface.-Gaillard's Southern Medicine. IMMUNIZATION AGAINST CANCER. Although the present trend of treatment of cancer has been entirely in the direction of early extirpation with the knife, it is not unlikely that any day may bring forth some discovery which will place the disease within the reach of medicinal therapeutics. So long as nothing positive is known in regard to the etiology of malignant growths investigators are necessarily groping in the dark, but it must be remembered that, after all, many of our therapeutic triumphs are the outcome of accidental occurences. As Drs. Gaylord and Clowes have recently shown, spontaneous cures of cancers in mice successfully inoculated with the disease result in about 23 per cent, and a small but positively proven number of such cures in human beings are on record. The investigations in which Professor Ehrlich is at present engaged appear very promising. Briefly speaking, he found that by successive transplantations of cancerous material through a series of mice a remarkable augmentation of virulence could be obtained, so that the introduction of this virus produced almost constantly a malignant formation; whereas, commonly the percentage of successful transplantations of cancer is small. On the other hand, previous inoculation of the mouse with ordinary tumor material, although no growth occurred, effected such a change that even the augmented virus failed to cause the disease; hence these animals must have acquired a true immunity. Therefore, the hope is not vain that, starting from this, Ehrlich or some other investigators may in the near future discover some-thing, perhaps a serum, which will, to use the words of Gaylord, act as an immune force antagonistic to the cancer cell, and thus enable us to directly arrest its proliferation.-International Journal of Surgery. PRIMARY MALIGNANT DISEASE OF THE VERMIFORM APPENDIX. H. D. Rolleston and L. Jones have been able to collect records of sixty-two supposed examples of this localization, including one hitherto unpublished, and their paper, which closes with a complete bibliography, is an analysis of these records. For various reasons they exclude twenty cases as not conclusive. Of the remaining forty-two, thirty-seven were diagnosticated as carcinoma, three as endothelioma, and two as sarcoma. The age limits were twelve and eighty-one years. In only five of the fortytwo were secondary growths recorded. In thirty-three, in which exact situation is given, nearly one-half were localized in the distal third of the appendix. The authors find it impossible to build up a clinical syndrome, and, in fact, as far as they can learn, a correct diagnosis has never been made before operating. Symptoms were variously referred to the female pelvic viscera, fistula following iliac abscess and acute appendical attacks. Of the latter (twenty-seven) symptoms of the first acute attack accounted for ten cases; chronic symptoms, with an acute attack, three cases; recurrent attacks, nine cases, and chronic appendicitis, five The growth, it appears, may be either the cause or the effect of the changes producing the symptoms, and may give rise to the symptoms of appendicitis; it is probably the cause in those cases with an apparently acute onset, or in which the symptoms, having been chronic, the growth is the main feature of the appen cases. dix. It is probably the outcome of chronic irritation in those cases of obliterating appendicitis in which the growth is recognized by the microscope only. The extent of the operation called for rarely exceeded the simple removal of the appendix. The results of operation were surprisingly good. There were four deaths within two weeks of operation. Of twenty-nine patients who recovered, one died four months later after operation to relieve obstruction caused by a band in the right iliac fossa, but there was no recurrence of malignancy. None of the others presented any suggestion of recurrence.-Gaillard's Southern Medicine. THE SURGICAL TREATMENT OF PUERPERAL PYEMIA. In his introductory address on surgery before the Section on Surgery and Anatomy of the American Medical Association, Professor Trendelenberg (Journal A. M. A., July 14) treats especially of the surgical treatment of puerperal pyemia. He points out that at the present time we ordinarily have only to deal with pyemia as it occurs from aural or uterine infection. The surgical treatment of otitic pyemia by clearing out of the thrombosed transverse sinus, with or without ligature of the jugular vein, is well established, the only difference of opinion being confined to details. He asks why this same plan of surgical procedure can not be followed in puerperal pyemia with like good results. He points out the pathologic similarities between the conditions and questions the statistics that have been used or that may be used against the employment of surgical measures for the relief of this condition. Even with a mortality of only 50 per cent, under non-surgical treatment it is one of the most serious and fatal maladies to which women are subject. The as yet limited number of successful cases of ligature of the pelvic vems for this condition indicates that we are on the right track, and he believes that the surgical treatment of puerperal pyemia will follow the same road to professional favor as has that of otitic pyemia. The prognosis can only be favorable in acute cases with early operation, as the thrombotic process rapidly extends upward, even to the vena cava, while in the chronic cases its advance may be restricted to the internal iliac and ovarian veins after a lapse of several weeks. Although a sufficient collateral circulation may be established even after obliteration of the vena cava, he would not advocate this procedure. He does advise, however, ligation of the internal iliac and ovarian veins at an early period in acute puerperal pyemia in order to prevent the extension upward of the thrombosis. In cases of doubtful diagnosis an exploratory exposure of these veins is in his opinion as justifiable as in cases of abdominal injury or in gastric cancer. The danger of such an operation is not to be considered in comparison with the greater one that threatens the patient's life from the disease. The relative merits of the transperitoneal and the extraperitoneal routes for the operation are discussed. The former is perhaps the simpler, but it involves the danger of peritoneal infection by the septic material from the veins when the latter are opened accidentally or otherwise, and they can not be cleaned out thoroughly for this reason. The extraperitoneal operation calls for a much larger incision if the veins are followed up to their full extent, and is perhaps also more difficult and tedious. The danger to the peritoneum, however, is lessened, and the veins can be opened and cleared out. Experience has not shown the invariable necessity of the latter procedure as practiced by otologists on the sinus; the exclusion of the thrombus from the circulation, by ligation, preventing the contamination of the venous blood, often seems all sufficient for the purpose. The incision is made as for ligation of the iliac artery, above Poupart's ligament, and then upward to the tip of the eleventh rib. It may be possible to utilize both methods with advantage; experience must decide.—Memphis Medical Monthly, REFLEX SYMPTOMS AND REFERRED PAINS CAUSED BY STONE IN THE KIDNEY. Stella Stevens Bradford gives the history of a patient whose principal symptoms were nervous exhaustion and pain and weak |